Trying to conceive for a year? Why both partners should be checked

A year of trying without success is worth acting on — and it's worth knowing, from the start, that this isn't only about one partner.

What counts as infertility?

Infertility is the inability to conceive after regular unprotected intercourse for 12 months in women under 35 years old. A woman over 35 should see a doctor after 6 months of being unable to conceive despite regular unprotected intercourse.

Is infertility the woman's fault?

No, not in all cases — only about a third. In another third of cases the male partner has a factor causing difficulty conceiving. For the rest, the cause is unknown or unexplained.

Who should be evaluated first?

Both the male and female partner should be evaluated together.

What causes male infertility?

Common causes include low sperm count, poor sperm movement, abnormal shape, varicocele, hormonal disorders, infections, genetic factors, and lifestyle factors such as obesity and smoking.

A varicocele — one of those causes — is a dilated loop of veins surrounding the testicles. It affects sperm quality, and in selected cases, surgical removal has been seen to be beneficial.

A low sperm count can be treated in most cases. If the cause is known, treating it can improve the count dramatically — for example treating an infection, quitting smoking, weight management, surgical correction of a varicocele, or hormonal treatment where the cause is hormonal.

What is semen analysis?

Semen analysis is a test done on the male partner's semen — sperm count, movement, volume, and shape — to assess male infertility. It's the basic test done.

To collect the sample, the couple is advised abstinence for 2 to 5 days. The male partner produces the sample by masturbation, ideally in a laboratory setting. If the first report is abnormal, the test should be repeated after 90 days before drawing conclusions.

What causes female infertility?

Common causes include ovulation disorders, blocked fallopian tubes, endometriosis, uterine abnormalities, hormonal disorders, and age-related decline.

Endometriosis can reduce fertility by affecting the ovaries, tubes, and overall pelvis — though many women with mild endometriosis conceive naturally, and others conceive with appropriate treatment.

Fibroids don't affect fertility in most cases. But if they're large, blocking the fallopian tubes, or involving the lining of the womb, they may reduce implantation and increase miscarriage risk; treatment depends on size, location, and symptoms.

Certain pelvic infections can lead to infertility by causing permanent damage to the tubes — early assessment can save you from these consequences. Most abortions managed medically or surgically do not lead to infertility if handled with expert care; in rare cases, a severe infection or damage to the uterus during surgical evacuation can lead to secondary infertility.

What tests does a woman need?

A pelvic ultrasound, hormonal tests, ovarian reserve tests such as anti-Mullerian hormone or antral follicle count, and tubal patency tests. Tubal patency specifically can be assessed by X-ray of the fallopian tubes or by laparoscopy.

Ovarian reserve isn't assessed in every woman with infertility — but in patients over 35, it's assessed either by antral follicle count on ultrasound or by a blood test for anti-Mullerian hormone (AMH).

More questions our doctors have answered

Can blocked fallopian tubes be treated?

Yes. If the damage is limited, surgery may help. In cases of greater damage, IVF may be attempted to achieve pregnancy.

Can infertility be cured?

Infertility has many causes, and most are treatable if picked up early. Depending on the cause, your doctor may offer lifestyle modification, medications, surgery, intrauterine insemination (IUI), in-vitro fertilisation (IVF), or intracytoplasmic sperm injection (ICSI).

IUI means intrauterine insemination — it's used in some cases of mild male factor infertility, where prepared sperm from the male partner is placed directly into the uterus at the time of ovulation. IVF means in-vitro fertilisation — eggs are retrieved from the woman and combined with the male partner's sperm in a laboratory, so the embryo forms outside the body and is then placed in the uterus; it's used for unexplained infertility, tubal damage, or where other methods have failed. ICSI, intracytoplasmic sperm injection, is a technique in which a single sperm is injected directly into an egg, used for severe male factor infertility.

None of these methods guarantee a successful pregnancy. However, they can be used to improve the chances of pregnancy.

Is pregnancy still possible after an infertility diagnosis?

Yes. Many couples diagnosed with infertility eventually achieve pregnancy, naturally or with treatment. Early assessment and early treatment are important.

Can I conceive at 40-plus with a low AMH?

Yes, pregnancy is still possible at this age and with low AMH levels, as hormones fluctuate from time to time. However, such a pregnancy needs close monitoring, as the risks of miscarriage and chromosomal disorders are higher.

(If your periods are irregular alongside difficulty conceiving, our guide to PCOS and fertility covers one common hormonal cause and how it's evaluated separately from the causes above.)